DERRICK EARNEST ROLLO DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051736

License Status

CANCELLED

Business

First Name

DERRICK

Middle

EARNEST

Last Name

ROLLO

Suffix

Business Name

DERRICK EARNEST ROLLO DO

Original Issue Date

09/20/2007

Effective Date

09/20/2007

Expiration Date

09/19/2009

City

URBANA

State

Zip

61801

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/20/2007